The central aim of the research activities proposed in this application is to develop, evaluate, and disseminate effective treatments for difficult-to-treat patient populations, especially those meeting criteria for borderline personality disorder (BPD), suicidal individuals, those with primary psychotic disorders). Specific aims are as follows. Aim 1 is to develop a body of randomized controlled trials (RCT) evaluating the efficacy and effectiveness of Dialectical Behavior Therapy (DBT) for suicidal and other BPD patients. DBT has been shown efficacious in two clinical trials, one with suicidal BPD patients and one with drug abusing BPD patients. This aim will be accomplished by continuing several ongoing treatment studies. The first is a RCT comparing DBT with expert-community individual psychotherapy (CIP) for chronically and currently suicidal women meeting criteria for BPD. To date, 60 of 120 projected subjects have been entered into treatment in this ongoing study. The second study targets opiate addiction among BPD women and is a projected RCT comparing DBT with a component-control treatment condition, Comprehensive Validation Treatment (CVT). Twenty-four training cases of a projected 144 subjects have been entered into treatment with 3 DBT therapists and 2 CVT therapists for this study. Two treatment development studies are in their initial stages and are projected to lead into future RCT's. The first of these targets methamphetamine addicted BPD women and the second focuses on AIDS prevention. Aim 2 is to analyze data from current outcomes studies to better understand predictors of treatment response. A wide number of assessments instruments have been administered and specific hypotheses about patient characteristics and outcome will be tested. Aim 3 is to support research on DBT at other research sites and to foster collaboration among various research sites interested in DBT research. The PI is consulting on a large number of DBT research studies currently funded and in progress at sites in the United States and Europe. Aim 4 is to train a cadre of expert DBT therapy trainers and researchers to continue to develop and improve treatment for treatment resistant populations. This will be accomplished with a systematic training and mentoring program for graduate students and visiting scientists at the University of Washington.